6/15/2007 @ 6:00AM

The Best And Worst States For Health Care

In Texas, more than 30% of adults under age 65 did not have health insurance in 2004 to 2005. In fact, during the past five years, the number of uninsured adults has increased in 44 states. Throughout the country, only one in four adults over the age of 50 receives preventative care. And in 2004 in Mississippi, nearly 20% of those that needed to see a doctor didn’t do so because it was too expensive.

The overall message: “Where you live really matters in terms of your experience with the American health care system,” says Karen Davis, president of the Commonwealth Fund, the independent group that conducted a new study of the best and worst states for health care.

The report is the first of its kind to rate each state in the following categories: access to health care, quality of coverage, costs and preventability of hospital admissions, how the poor and uninsured fare under a state’s particular system, and the general healthiness of people’s lives. The study ranks the states using 32 criteria.

Some of the results are not entirely surprising. Wealthy areas of the country, such as the Northeast, typically have good health care systems; poorer areas, like the South, do not. Overall, the Commonwealth Fund rates Hawaii, Iowa, New Hampshire, Vermont and Maine as the best, while Oklahoma, Mississippi, Texas, Arkansas and Nevada as the worst.

The study comes up with several key findings. Access to health insurance and the quality of the care one receives are closely correlated, but the quality and cost of this care are not. And even the best states sometimes have shortcomings in their health care systems. Just look at Minnesota, where only 50% of adults over 50 years old receive preventative care–and that’s the best rate in the country.

The relationship between access and quality is somewhat of a no-brainer: If you don’t have health insurance, it’s hard to get good care. In 1974 Hawaii became the first state to require all employers to provide health insurance to their full-time workers. It now has the overall best health system among any state, according to the Fund.

But then there’s West Virginia, where more than 24% of adults under age 65 don’t have health insurance. In that state, employer-based insurance premiums account for nearly 20% of a person’s paycheck, and nearly 20% of those surveyed in the state have said they couldn’t see a doctor because it was too expensive to do so. The state ranks 44th out of 51 (including Washington, D.C.) in terms of overall health care, the Fund says.

The quality of care in each state is not easy to quantify. The Fund uses factors including access to the right type of care for various illnesses, the percentage of adults who receive preventative care and the percentage of infants that have key vaccinations. But it doesn’t include variables like hospital efficiency and safety, and control of chronic diseases–key elements for which some states don’t have accurate data.

Much of the high costs associated with health coverage in each state have to do with Medicare spending, which tends to be a good cost benchmark because it has a nationwide benefit structure. Repeat admissions to hospitals that are potentially avoidable–like emergency room visits for childhood asthma–drain Medicare spending. In Nevada, 24% of all Medicare patients are readmitted within a month. According to the study, if visits such as these were reduced, Medicare costs could be diminished by $5 billion to $7 billion annually.

The Commonwealth Fund’s report is essentially a case for universal health coverage. “Moving toward universal coverage is critical for improving quality and delivering more cost-effective care, as well as ensuring access to care,” it says.

Unfortunately, it doesn’t provide much guidance on how to get there. That, apparently, is a conundrum for presidential candidates and lawmakers to wrestle with.